P wave synchronous pacing using anchored atrial electrode implanted without thoracotomy

A new technique for the transvenous implantation of a specially designed atrial sensing electrode is described. In combination with a ventricular stimulating electrode and an atrial-controlled pacemaker, the method enables synchronization of atrial with ventricular activity. The atrial sensing electrode is put into the right atrial appendage through a preshaped radiopaque Teflon applicator catheter. Two hooks on the electrode tip provide for safe and secure anchoring of the electrode tip to trabeculae of the atrial appendage. The technique has been used for synchronous P wave pacing in 12 patients with complete atrioventricular block, most of them suffering from AdamStokes attacks. Three additional patients with sinoatrial block were treated by means of anchored atrial electrodes. Observation periods of up to 39 months showed no dislocation of any of the anchored atrial electrodes, and performance in all patients was faultless.